Hospital Organizational Design Can Impede Patient Transitions, AHRQ-Funded Study Finds

Hospital organizational design poses challenges for doctors in maintaining a high standard of medical care during a patient’s transition from the emergency department to an inpatient unit, according to an AHRQ-funded study. Doctors spent considerable time recognizing and responding to changing situations during patients’ transition of care, researchers found. And physicians’ divided attention could be further impacted by factors such as heavy reliance on technology rather than face-to-face hospital staff interaction and a lack of consistent procedures during care transitions. Structured coordination interventions such as checklists, care pathways and standardized protocols were identified as primary ways to improve care transitions between teams, the study indicated. The study, “Navigating Care Transitions: A Process Model of How Doctors Overcome Organizational Barriers and Create Awareness,” and abstract appeared in the February issue of the journal Medical Care Research and Review.

2015 Feb;72(1):25-48. doi: 10.1177/1077558714563170. Epub 2014 Dec 16.

Navigating care transitions: a process model of how doctors overcome organizational barriers and createawareness.

Hilligoss B1, Vogus TJ2.

Author information

Abstract

As reforms push for improved integration across the care continuum, managers and policy makers are increasingly concerned about care transitions, such as during shift changes or when moving patients between units or institutions. The authors examined transitions from an emergency department to inpatient units through a 2-year ethnographic study of an academic medical center. Data include 48 semistructured interviews withdoctors and administrators and 349 hr of observations of doctors. The authors show that organizational design poses challenges to doctorsattempting between-unit care transitions, including heavy reliance on technology, separation of responsibility and control, and misalignment of routines and temporal rhythms. Each challenge threatened doctors' awareness of the current state of other units and processes. To recoverawareness, doctors engaged in time-consuming workarounds. Improved awareness will likely require a mix of interventions, including standardized protocols, work redesign, advanced information technologies specifically designed to enhance awareness, and high-reliability practices, such as safety organizing.